Bret Scher, MD - Figure 53
What to do about increased LDL?
Then, of course: medications. We have so many examples in medicine where we use a medication to treat a medical condition, and then we have to use another medication for some of the side effects. Similarly, in this setting, maybe you do treat the elevated LDL with medication, while keeping somebody on their ketogenic diet. Of course, statins are first line therapy, though there are many other options now, with PCSK9 inhibitors and others. I mention ezetimibe…again, this is unpublished clinical experience: Ezetimibe appears to work better in terms of lowering LDL in this specific population than in the general population. I think that's fascinating because it comes back to: What is the etiology of the elevated LDL? If it's from an absorption standpoint, it would make sense that ezetimibe would work better, because it's a gut focused medication. This is just a hypothesis at this point – but really interesting – and I think it drives home the point that maybe we shouldn't view all LDLs the same, but the etiology for elevated LDL might make a difference.